Application for Employment / Human Resources
Use Only
Send completed application form to:
Walla Walla Valley MPO/SRTPO6. E. Chery St.
Walla Walla, WA 99362
email address: / You must submit a separate Application for each position.
Read the Position Opening Announcement to see if a Supplemental Questionnaire is required.
DO NOT submit a photograph of yourself.
TheMPO/SRTPO is an Equal Opportunity Employer and does not unlawfully discriminate on the basis of race, sex, age, color, sexual orientation, religion, national origin, marital status, genetic information, veteran’s status, disability, or any other basis prohibited by federal, state or local law.
Complete all information from this point forward. An incomplete Application may disqualify you from further consideration.
Applicant: Enter Job # here / Applicant: Write the Position Title of the Job you are applying for hereName
(Last) / (First) / (Middle)
Address
City
/ State / ZipHome Phone / ( ) / Cell / ( ) / Work / ( ) /
Do you have, or can you obtain, a valid Driver’s License? / Yes No
Do you wish to claim Veteran’s Preference for testing, pursuant to RCW 41.04.010? / Yes No
TRAINING AND EDUCATION
Highest Grade Completed: 8 9 10 11 12 GED
Colleges/Other Training Subject/Major Degree/Certificate Date Completed
EQUIPMENT, OFFICE AND COMPUTER SKILLS
Describe computer and other equipment operation skills. Include programs used, typing speed & other information relevant to the position for which you are applying.
CRIMINAL CONVICTION
The Agency is mindful of its obligation to employ qualified persons and its entitlement under law to consider an applicant's convictions record as it relates to job performance. A conviction record will not disqualify you for employment unless such record would reasonably affect your fitness for the job for which you have applied. Have you been convicted of a felony or released fromprison within the last ten (10) years, or have been convicted of a misdemeanor other than minor traffic offenses within the past three (3) years? YES NO
If Yes, Please Provide Details Regarding the Crime and the Sentence or Fine Imposed
PROFESSIONAL REFERENCES (Do Not List Relatives)
Name/Title / Employer / Phone / ( )
Name/Title / Employer / Phone / ( )
Name/Title / Employer / Phone / ( )
SIGNATURE IS REQUIRED
To the best of my knowledge, the information herein is true and complete. I have read the Position Opening Announcement and I can perform the essential functions of the position for which I am applying, with or without reasonable accommodation. I understand that if I receive a Conditional Offer of Employment for a position where I will have unsupervised access to children, developmentally disabled persons, or vulnerable adults, the MPO/SRTPOis authorized to complete a thorough background check as required by the Child/Adult Abuse Information Act. I authorize investigation of all statements in this application. I understand that providing false information on this application is grounds for disqualification and/or dismissal. If I am applying for an exempt position, I understand that nothing in this application or my communications with any MPO/SRTPO official is intended to create an employment contract between the MPO/SRTPO and me.
Signature / Date
WORK HISTORY
Beginning with your present or most recent employment, list your work/experience history for the last 10 years or experience prior to that time which is directly related to the position for which you are applying. Attach additional sheets as necessary. Be sure to include any non-paid experience which is related to the job for which you are applying. Complete the following sections even if you are submitting a resume in addition to this application. An incomplete application may disqualify you. If you have been known by a different name by any of these employers, please identify the employer and state the name here : ______
Employer's Name / From / Mo/Year / To / Mo/Year
Address / Supervisor
Phone / Hours Worked Per Week
Position / Start Salary
Number Of Employees Supervised By You / Last Salary
Reason For Leaving
Primary Duties
Employer's Name / From / Mo/Year / To / Mo/Year
Address / Supervisor
Phone / Hours Worked Per Week
Position / Start Salary
Number Of Employees Supervised By You / Last Salary
Reason For Leaving
Primary Duties
Employer's Name / From / Mo/Year / To / Mo/Year
Address / Supervisor
Phone / Hours Worked Per Week
Position / Start Salary
Number Of Employees Supervised By You / Last Salary
Reason For Leaving
Primary Duties
Walla Walla Valley MPO/SRTPO
6 E.Cherry Street
Walla Walla, WA 99362
email address:
AUTHORIZATION TO RELEASE EMPLOYMENT RECORDS
References will only be checked for finalists.
Current and/or prior employers will only be contacted after an applicant has been notified that he/she is a finalist. I certify that the information given by me to the agency is true and complete to the best of my knowledge. I understand that falsification of this application will be grounds for elimination from further consideration or, if employed, may result in discipline up to and including immediate dismissal. I further certify that I am not engaged in any outside activity or business that could be considered in conflict with the MPO/SRTO interest or those of its clients, nor will I become engaged in such activity or business if employed.
I, the undersigned applicant for employment with the MPO/SRTPO, in consideration of the review of my employment application, do authorize the agency to solicit information regarding my character, general reputation, previous employment, and similar background information, and to contact any and all prior employers or references I have given on my application. I hereby release all parties and persons connected with any such request for information from all claims, liabilities, and damages for any reason arising out of the furnishing of such information. If employed, I release the MPO/SRTPO from any liability for future references it may provide regarding my work history at the MPO/SRTPO.
If employed, I further agree that if I lose, damage, or fail to return any of the MPO/SRTPO’s property, the MPO/SRTPO is authorized to deduct from my wages sufficient reasonable funds to replace its property.
It is my intention that any copy of this authorization be as effective as the original.
DateName (Please Print)
Signature
THIS PAGE WILL BE REMOVED FROM THE APPLICATION AND KEPT SEPARATELY
Name: ______
Please Print Last First MI
Job #:______
We would appreciate completion of the information below. This is entirely voluntary. The MPO/SRTPO is committed to non-discrimination in employment practices. This information will be kept confidential and will be used for EEO record keeping purposes only.Sex / Female Male
Ethnic Category (Check one) / Caucasian African American Hispanic or Latino Asian
Native Hawaiian or Other Pacific Islander Alaskan Indian Native
American Two or More Races Other______
Please tell us how you learned of this opening by circling the number of the source
1.Local Media ______
2.MPO/SRTPO contact
3.Internet (general)
4.Jobs Available5.AWC Job Net
6.School/College
/7.Friend/Relative
8.MPO/SRTPO Employee
9.Professional Publication/Internet Site
10.MPO/SRTPO website
11.Other
APPLICATION ASSEMBLY and HIRING PROCESS:Assemble application materials in this order: 1: Cover Letter, 2: MPO/SRTPO Application Form, 3: Resume, 4: Supplemental Questionnaire, 5: Authorization To Release Employment Records, 6: Current driver’s abstract, and 7: Please make this sheet the LAST PAGE as it will be removed. Staple everything together in the top left corner.
Those applicants who submit a completed and timely application and are invited to participate in the interview process will be notified by phone or email. Incomplete or late applications will not be accepted. Application screening is scheduled to begin on the first business day following the closing date and may take 5-10 business days.
Thank you for considering us as your prospective employer.
Page 1 of 4